This population-level Markov simulation study (n=350,000 initial patients + 11,296 annually) models the economic impacts of intravenous ketamine versus ECT for treatment-resistant depression over 5 years. The model projects annual societal savings of $828.2 million ($95.3M to patients, $743.7M to payers) with expanded ketamine access, though with an added $10.8M annual caregiver burden.
Abstract of Impact analysis of expanded access to ketamine for treatment-resistant depression
“Aim: This study aimed to estimate the economic impacts of expanded access to ketamine relative to electroconvulsive therapy (ECT) by offering intravenous ketamine to US patients with nonpsychotic treatment-resistant depression (TRD) and moderate-to-severe depression.
Materials & methods: A population-level Markov simulation model with key parameters from a randomized trial was used to simulate the economic impacts of managing TRD with intravenous ketamine versus ECT over a 5-year horizon. Health states included response of depression in the acute treatment phase and continued treatment and relapse in the maintenance phase. The model estimated costs associated with healthcare utilization (direct costs) and time loss (indirect costs) from patient, caregiver, payer and societal perspectives. Model uncertainty was assessed with one-way sensitivity, probabilistic sensitivity and scenario analyses.
Results: In year 1, our model included 350,000 eligible patients. In years 2 through 5, our model added 11,296 eligible patients annually. Expanded access to ketamine to manage TRD was projected to increase the number of patients receiving treatment by 75,000 patients in year 1 and 4292 patients annually in subsequent years. Over 5 years, expanded access to ketamine would result in a net positive societal savings of $828.2 million annually ($95.3 million to patients and $743.7 million to payers). However, expanded ketamine access would impose an additional $10.8 million burden on caregiver time annually.
Conclusion: For US patients with TRD and moderate-to-severe depression, ketamine may be a noninferior treatment relative to ECT to improve depression symptoms. Expanded access to ketamine treatment would result in net savings to the patients, payers and society.“
Authors: Thanh Lu, Sophia D’Angelo, Zohra Tayebali, Matthew Dempsey, Kristen Giombi & Olga Khavjou
Summary of Impact analysis of expanded access to ketamine for treatment-resistant depression
Major depressive disorder (MDD) is a serious and widespread mental health condition characterised by persistent low mood and a loss of interest in daily activities for at least two weeks. In the United States, over 21 million adults experienced a major depressive episode in 2021, with only half receiving treatment. A significant portion of these individuals—approximately one-third—suffer from treatment-resistant depression (TRD), defined as a lack of satisfactory response to at least two antidepressant medications.
TRD has substantial clinical and societal implications, including increased rates of self-harm, disability, and healthcare usage. It also contributes significantly to the economic burden of depression, with TRD accounting for 27% to 42% of the $326 billion annual cost associated with MDD in the USA.
Electroconvulsive therapy (ECT) has long been a primary treatment for TRD. Administered under anaesthesia, ECT involves delivering electrical currents to the brain and typically requires 6 to 12 sessions. Following initial success, patients often receive maintenance ECT or antidepressant medications to prevent relapse.
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Impact analysis of expanded access to ketamine for treatment-resistant depression
https://doi.org/10.57264/cer-2024-0233
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Cite this paper (APA)
Lu, T., D'Angelo, S., Tayebali, Z., Dempsey, M., Giombi, K., & Khavjou, O. (2025). Impact analysis of expanded access to ketamine for treatment-resistant depression. Journal of Comparative Effectiveness Research, (0), e240233.
Study details
Compounds studied
Ketamine
Topics studied
Economics
Treatment-Resistant Depression
Depression
Study characteristics
Double-Blind
Participants
395184
Humans